In my last blog entry, I talked about why simply saying “let me know if it hurts” is not effective. Yet, we still need feedback from our clients. We honestly can't always tell when something hurts.
So, what do we do? I think much of the answer lies in our intakes.
A good intake is, in essence, a skilled interview. A good interview is one part technical skill and one part art form.
By “technical skill” I mean skill in structuring your questions in such a way that you elicit the kind of information most useful to you. A good instructor can teach you the basics but you only get good at it with practice. You hone this skill over time.
By “art form” I mean the ability to structure the more subtle elements of your intake to create a relationship where you and the client are naturally inclined to open communication and connection. Some of this can be taught in a classroom. Most of this comes with time and maturity.
Technical Skills
My undergraduate degree is in journalism. I spent a lot of time learning what to ask and how to ask it. That's the essence of the technical skills of a good intake.
Think about the kinds of questions asked by news people. Compare the “at the scene of the crime” interviews conducted by your local news station to, say, a “60 Minutes” or Barbara Walters interview.
Usually, no comparison. The “60 Minutes” team and Barbara Walters look prepared, they look experienced. You can tell they've done this before.
“60 Minutes” and Barbara Walters are also much better at follow-up questions. They recognize when an answer is incomplete, vague, or (ahem) smells funny. When that happens, they keep asking. They come at the question from a different angle. They point out discrepancies in the answers.
While a good intake should not feel like you're being grilled by an investigative reporter, there are things we can learn from these interviewers.
1. Breathe. Before you ask your question and after the client answers, pause a few beats and say nothing. It will force you to slow down and it will help you focus. It will also give you time to actually process the question / answer.
2. Ask both open-ended and close-ended questions. Sometimes you need a specific piece of information (when was that surgery?). Sometimes you need to create space for your client to share an experience (what happens to your life when your lupus flares up?). Think about when you need data vs. when you need to understand an experience.
3. Know why you're asking the question. One of my ongoing complaints with health history forms is asking for information the MT can't possibly need. For example “List all the dates you've had PMS”. “Do you or have a family history of diabetes?” “How much do you weigh?” If a client asks you why you asked the question you just asked, you need to be able to show them how that information is useful to you; specifically, how will the answer feed into the massage they are about to receive? A bad answer is “because they told me to in school” or “because all the MTs I know ask this question” or “because I see this question on my doctor's health history”.
4. Get clear on the information you can actually use. This is a follow-on to #4. Let's say you ask me if I smoke. When I ask you why you need to know, you say “because smokers often are more prone to bronchitis and have more problems with lung congestion”. If you want to know if I have bronchitis or lung congestion, ask that. Do you really need to know if I've ever been pregnant or do you need to know if I've ever had C-section?
5. When they’re on the table and you encounter a lot of tissue resistance, ask “how does that feel on the inside?” rather than “does it hurt?” “Hurt” has a lot of baggage around it. Asking them to find the language to describe their experience brings them into it. If they say something vague like “it’s OK”, ask them to be more specific.
The Art Form
Asking great questions in a well-suited environment massively improves the odds of good communication.
1. Sit down and face each other. You can't do a good intake by tossing questions over your shoulder while you change the sheets on the table. Your client often needs to physically slow themselves down so they can be present to the session. Maybe you do too. Sitting down helps. Looking directly at your client (as opposed to looking primarily at the health history form) makes a huge difference.
2. Take as long as it takes. When someone feels they’ve really been heard, they listen better themselves. Sometimes that means letting clients tell you the “story” of their physical condition, even though you can tell they've told it so many times it’s now coming out like a recording. Think about how many people don’t listen to them, especially health care practitioners. Be a better experience for them than that.
3. Learn how to be comfortable with silence. You don’t need to have a response for everything they say. Sometimes body language that indicates that you’ve heard them and are still listening is enough.
4. Explain what you mean by “pain”. The odds are that even two massage therapists don’t define or explain it the same way. What are the odds that you and your client understand it exactly the same way? I talk to clients about “productive” and “unproductive” pain.
Maybe you like the “on a scale from 1 – 10” approach. That works….if you’ve define what 1, 5, and 10 mean in terms that work in the client’s world (not just yours). What would be the signs – in the client’s awareness – of a 1, 5, or 10? I was joking recently with a client that 1 = you hear a dog barking a couple of houses down, 5 = you hear the dog barking next door, and 10 = you hear the dog barking under your chair. Goofy but memorable enough to possibly be useful.
5. Tell them why you need to know if it hurts and what you will do if they speak up. That’s not as obvious to our clients as you might think. They may also be concerned you’ll stop massaging an area if they speak up.
6. Don’t assume the health history has captured their reason for getting a massage. Health history forms tend to capture medical data. People come to massages for reasons other than physical pain. Your health history may not have asked a question about the specific thing that’s hurting them if they are here for pain relief. Ask them directly why they decided to schedule a massage today. At the end of your intake, summarize what you believe to be the goals the client has for the session.
Professional journalists spend their entire professional career honing their interview skills. We should too.
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